Eastern Cardiothoracic Surgical Society

Preoperative CT Scans Reduce the Risk of Stroke in Minimally Invasive Mitral Valve Surgery: A Meta-Analysis
Faiza M. Khan, Jeremy R. Leonard, Matthew Henry, Mohamed Rahouma, T. Sloane Guy, Leonard N. Girardi, Mario Gaudino, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA

OBJECTIVE: Minimally invasive mitral valve surgery (MIMVS) is performed with increasing frequency. Recent evidence suggests that patients undergoing MIMVS have an increased risk of perioperative stroke, mainly due to retrograde aortic embolization during femoral cardio-pulmonary bypass. Systematic pre-operative CT screening allows visualization of the aorta and femoro-iliac vessels and individualization of the surgical approach to the anatomic and pathologic characteristics of the single patient. In this meta-analysis, we aim to determine if systematic pre-operative CT screening decreases the incidence of perioperative stroke and other complications following MIMVS.

METHODS: A comprehensive online review was performed in PubMed from inception to May 2018. Eligible studies reported MIMVS with retrograde arterial perfusion. Studies were separated into two subgroups: systematic pre-operative CT screening (CT group) and no CT screening (Non-CT). Pooled event rates (PER) for operative mortality, perioperative stroke, perioperative myocardial infarction (MI), and new onset renal failure requiring dialysis were estimated and inter-group comparisons were performed.

RESULTS: 57 studies (13,602 patients) were analyzed (19 CT group and 38 Non-CT). The PER for perioperative stroke was 1.98% (CT group: 1.46% vs Non-CT 2.21%, p=0.03). The PER for new dialysis was 1.87%, significantly lower in the CT group (0.83% vs 2.33%, p=0.02) (Table 1). The PER for operative mortality was 1.36% with a trend towards better outcomes in the CT group (0.80% vs. 1.60%, p=0.052).

CONCLUSIONS: Systematic pre-operative CT screening is associated with significantly lower risk of perioperative stroke, need for dialysis, and a trend toward lower operative mortality after MIMVS.

Table 1 – Meta-Analysis Outcome Summary

Studies Pooled Event Rate (95% CI) P value a
Stroke (All) 57 1.98% (1.62-2.43)
Stroke (CT group) 19 1.46% (1.09-1.95) 0.03
Stroke (Non-CT) 38 2.21% (1.72-2.82)
Operative mortality (All) 56 1.36% (1.03-1.81)
Operative mortality (CT group) 18 0.80% (0.43-1.49) 0.052
Operative mortality (Non-CT) 38 1.60% (1.16-2.19)
New dialysis (All) 36 1.87% (1.36-2.56)
New dialysis (CT group) 11 0.83% (0.36-1.90) 0.02
New dialysis (Non-CT) 25 2.33% (1.68-3.23)

ap-value comparing CT vs. Non-CT groups